Nerlynx Patient Assistance Programs

Nerlynx: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Nerlynx. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Puma Patient Lynx Support Program

(Program 1 of 2 — Scroll down to see them all )

Provided by: Puma Biotechnology, Inc.
PO Box 13185 La Jolla, CA 92039
TEL: 855-816-5421
FAX: 844-276-5153
Languages Spoken:
English, Others By Translation Service
Program Website
Program Applications and Forms
Medications
  • Nerlynx (neratinib maleate)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Determined case by case
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must be residing in the US or US territory
Application
  • Obtaining Doctor/Doctor's office must call, download or apply online
  • Receiving Complete online, download from website or faxed.
  • Returning The completed application can be faxed back or submitted online
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Contact program for details.
Additional Information
Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients. Free Trial Program: Contact Program for details.
Updated November 14, 2018

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Patient Access Network Foundation (PAN)

(Program 2 of 2 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Nerlynx (neratinib maleate)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 2018

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